Dental care is fundamentally important for everyone's overall health. Oral health is connected to systemic health through multiple biologic pathways, including chronic inflammation, bacteremia, and shared risk factors.
What are some risks of poor oral health?
Poor oral health, and particularly periodontal disease, has been independently associated with many other health concerns in everyone, not just cancer patients. Studies show that poor dental health increases risks of cardiovascular disease, diabetes, adverse pregnancy outcomes, respiratory disease, Alzheimer's disease, rheumatoid arthritis, chronic kidney disease, and cancer.
Poor oral health is linked to increased rates of certain cancers
Periodontal disease or tooth loss can increase the risk of head and neck squamous cell carcinoma about 2.5 fold. Lung cancer is increased about 2.3 fold, even after adjusting for smoking. Rates of gastrointestinal cancers are also increased: esophageal cancer is increased about 39 percent, pancreatic cancer about 35 percent, colorectal cancer 21 percent, gastric cancer 13 percent, and liver cancer 9 percent. Severe periodontal disease showed an even stronger association with a 79 percent increased risk of gastrointestinal cancer.
Why is oral health an important part of overall cancer care?
For patients who have good oral health and are diagnosed with cancer, it’s important to maintain and monitor their dental care. Oral health directly impacts treatment outcomes, quality of life, and often the ability to complete cancer therapy without interruption. Poor oral health can lead to serious complications, often delaying or interrupting cancer treatment. Being proactive about dental health and taking care of any pre-existing dental issues before treatment can prevent these issues and improve overall patient outcomes.
How can cancer treatments like chemotherapy, radiation, or targeted therapies affect the mouth?
These treatments can cause xerostomia (dry mouth), mouth sores, mucositis, dysgeusia (disorder of the sense of taste), and dysphagia (difficulty swallowing). They can affect the ability to eat, speak, and maintain adequate nutrition which can in turn impact quality of life. In some cases, aspiration risk is increased.
Most symptoms reverse after chemotherapy treatment ends. However, many head and neck cancer patients, especially after radiation treatment, can have residual symptoms, specifically dry mouth.
What are the most common oral complications cancer patients experience during treatment?
Cancer treatments, particularly radiation to the head and neck, chemotherapy, and hematopoietic cell transplantation, cause significant oral complications which can include mucositis, xerostomia (dry mouth), infections, and dental caries. Worst case scenario, cancer treatment can lead to osteonecrosis of the jaw, which can be very difficult to treat.
Why does maintaining good oral hygiene matter during cancer therapy?
Good dentition (defined as having at least 20 natural teeth) and frequent dental visits were associated with improved overall survival for head and neck cancer patients in a large pool analysis done by the International Head and Neck Cancer Epidemiology Consortium.
What steps should patients take to protect their oral health before starting treatment?
See a dentist and take care of any underlying dental issues before starting cancer treatment.
What daily oral care routine do you recommend for patients undergoing cancer treatment?
See a dentist regularly as part of your routine health. Every person, and especially cancer patients, should brush twice a day for at least two minutes with a fluoridated toothpaste, practice daily interdental cleaning (i.e. flossing or using a Waterpik), and get routine professional dental care. As the saying goes, you only floss the teeth you want to keep.
How can patients manage common side effects like dry mouth or mouth sores?
Oncologists use the National Comprehensive Cancer Network (NCCN) guidelines to guide treatment as well as prevention and management of side effects, including any related to oral health. Recommendations include:
- Increasing hydration and minimizing ingestion of caffeinated products and alcohol
- Using salivary stimulation through gustatory stimulants such as chewing gum, lozenges, prescribed medications, or salivary substitutes
- Switching to nonalcoholic mouth rinses or sprays and sugarless chewing gum or lozenges
Mouth sores in cancer patients are often managed with Magic mouthwash, which is a combination of diphenhydramine (antihistamine), viscous lidocaine (anesthetic), and an antacid like Maalox (coating agent). For certain therapies that are higher risk, we often prescribe prophylactic steroid rinses.
When should a patient contact their care team about oral symptoms?
Cancer patients should reach out to their care team as soon as they start experiencing any side effects, including those related to oral health. Magic mouthwash can often bring significant and immediate relief. The earlier we can treat the condition, the better the outcomes. That said, prevention is also the best strategy.
How does collaboration between oncologists and dental professionals benefit patients?
A partnership between oncologists and dental professionals improves patient outcomes by reducing treatment interruptions and preventing serious complications. Especially for head and neck cancer care, the NCCN guidelines include dentistry/prosthodontics as a core member of the multidisciplinary team.
Are there long-term oral health effects after cancer treatment ends?
This is particularly pertinent for radiation therapy to the head and neck which can include chronic xerostomia, radiation-related tooth decay or cavities, osteoradionecrosis, trismus (lockjaw), periodontal disease, and in pediatric patients, developmental dental abnormalities. Practicing good oral health—brushing twice daily, flossing, and seeing a dentist twice a year—can greatly improve your overall health and lower your risk of certain cancers. Having these routines in place and maintaining them should you undergo cancer treatment can greatly improve your outcomes following treatment. For more information on oral health, visit the National Institute of Dental and Craniofacial Research webpage.
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